Kids

Children with cerebral palsy often face a range of orthopedic challenges, and one of the most common complications is hip dysplasia. This condition occurs when the hip joint does not develop properly, leading to instability, misalignment, and in some cases, severe pain.

In children with cerebral palsy, especially those with spastic quadriplegia, muscle imbalances can pull the hip out of its socket over time, increasing the risk of dislocation. Early recognition of hip dysplasia is essential to prevent pain, improve mobility, and avoid long-term complications.

Dr. David Siambanes, a board-certified orthopedic surgeon specializing in pediatric orthopedics and spinal deformities, has extensive experience diagnosing and treating hip dysplasia in children with cerebral palsy. His expertise helps children maintain comfort, improve sitting tolerance, and reduce the risk of future mobility issues.

What is Hip Dysplasia?

The hip is a ball-and-socket joint, where the top of the thigh bone (femoral head) fits into the curved part of the pelvis (acetabulum). In children with hip dysplasia, this joint doesn’t form correctly. The ball may sit loosely in the socket or move partially — or completely — out of place.

For children with cerebral palsy, muscle tightness and imbalances can pull the hip out of alignment, gradually leading to hip subluxation (partial dislocation) or hip dislocation (complete separation of the ball from the socket). Without treatment, hip dysplasia can cause chronic pain, reduced mobility, and difficulties with sitting or standing.

Why Children with Cerebral Palsy Are at Higher Risk

Cerebral palsy affects muscle tone and control, often leading to spasticity (increased muscle stiffness) or hypotonia (decreased muscle tone). In children with spastic cerebral palsy, tight muscles can pull unevenly on the hip joint, gradually leading to misalignment.

Children who are non-ambulatory or spend much of their time in a seated position, such as those with spastic quadriplegia, are especially at risk. The lack of weight-bearing activities, like walking, can limit proper hip development, making dislocation more likely over time.

Common Symptoms of Hip Dysplasia in Children with Cerebral Palsy

Hip dysplasia symptoms can sometimes be difficult to detect, especially in non-verbal children who cannot express their discomfort. However, there are signs that parents and caregivers can watch for:

1. Pain and Discomfort

Pain is often the most noticeable symptom of hip dysplasia. Children may experience:

• Discomfort during diaper changes or when legs are moved
• Pain when sitting, especially for extended periods
• Crying or irritability when the hip is manipulated or under pressure
• Pain even while at rest in severe cases

Non-verbal children may express pain through agitation, crying, or changes in behavior.

2. Limited Range of Motion

Hip dysplasia can cause stiffness in the hip joint, making it difficult to:

• Spread the legs apart during diaper changes
• Move the hips into different positions
• Sit comfortably without leaning to one side

Parents may notice that one leg appears stiffer or harder to move than the other.

3. Asymmetrical Leg Positioning

Children with hip dysplasia often have one leg that appears longer or shorter due to the misalignment of the hip. Other signs of asymmetry include:

• One hip or buttock appearing higher than the other
• Uneven skin folds on the thighs or buttocks
• A noticeable tilt in the pelvis when sitting

4. Difficulty Sitting or Standing

When the hip is out of alignment, children may struggle to sit upright or balance evenly while standing. In wheelchair-dependent children, poor hip positioning can make it harder to maintain an upright seated posture, increasing the risk of pressure sores and spinal curvature.

5. Audible Clicking or Popping Sounds

In some cases, the hip may make clicking or popping sounds during movement. While not always painful, these sounds can indicate that the hip is unstable or partially dislocated.

The Importance of Early Detection

If left untreated, hip dysplasia can progress to a full dislocation, leading to severe pain and further limitations in mobility. Early detection allows for less invasive treatment options and can prevent long-term complications.

Dr. Siambanes emphasizes the importance of routine orthopedic evaluations for children with cerebral palsy. Using advanced imaging techniques and the Motion Analysis Lab, he can assess your child’s gait, posture, and joint health to catch early signs of hip dysplasia before it becomes more severe.

Treatment Options for Hip Dysplasia Symptoms in Children with Cerebral Palsy

The goal of treatment is to restore proper hip alignment, reduce pain, and improve function. Treatment plans vary based on the severity of the misalignment and the child’s overall mobility.

1. Non-surgical Interventions

• Physical Therapy can help strengthen surrounding muscles and improve hip positioning.
• Bracing or Orthotic Devices may be used to support the hip and prevent further misalignment.
• Botox Injections can reduce muscle spasticity around the hip, making it easier to maintain proper alignment.

2. Surgical Options

For children with significant misalignment or pain, surgery may be necessary. Dr. Siambanes specializes in procedures that relocate the hip joint and stabilize it within the socket. These surgeries are often performed between ages 7 and 12, allowing for optimal hip development as the child grows.

Surgical intervention can dramatically improve a child’s sitting balance, mobility, and overall comfort, especially for those who rely on wheelchairs or spend extended time in seated positions.

Supporting Your Child’s Comfort and Mobility

Recognizing the signs of hip dysplasia early is crucial in helping your child avoid pain and maintain as much independence as possible. If you notice any of the symptoms listed above or have concerns about your child’s hip development, don’t hesitate to reach out to a specialist.

Dr. Siambanes is committed to helping children achieve better mobility, improved sitting tolerance, and a higher quality of life. With expertise in both non-surgical and surgical treatments, Dr. Siambanes provides comprehensive care tailored to your child’s unique needs.

Schedule a Consultation Today

If you’re concerned about your child’s hip health, contact Children’s Cerebral Palsy to schedule a consultation with Dr. Siambanes. Early intervention can make all the difference in preventing pain and supporting your child’s mobility as they grow.

While cerebral palsy is often associated with high muscle tone, muscle stiffness and spasticity, some children experience the opposite — low muscle tone, known as hypotonia. Hypotonic cerebral palsy affects a child’s strength, posture, and movement, making everyday activities more challenging. 

What is Hypotonic Cerebral Palsy?

Hypotonic cerebral palsy is a less common form of cerebral palsy characterized by decreased muscle tone, which makes muscles feel floppy or weak. Unlike spastic cerebral palsy, where muscles are stiff and tight, children with hypotonia have difficulty maintaining muscle control and posture due to reduced muscle tension.

This condition results from damage to the parts of the brain responsible for muscle coordination, often occurring before, during, or shortly after birth. Because muscle tone plays a key role in movement, balance, and strength, children with hypotonic cerebral palsy may experience delays in reaching developmental milestones such as sitting, crawling, or walking.

Signs and Symptoms of Hypotonic Cerebral Palsy

Children with hypotonic cerebral palsy may show symptoms early in life, often appearing “floppy” when held. Some common signs include

• Delayed motor development: Difficulty lifting the head, rolling over, or sitting up without support.
• Poor posture: A tendency to slump forward or struggle to maintain an upright position.
• Weak muscle control: Arms and legs may appear limp, making movements uncoordinated.
• Difficulty swallowing or feeding: Weakened oral muscles can make eating and speaking challenging.
• Loose joints and hypermobility: The child may have excessive flexibility due to a lack of muscle resistance.
• Fatigue and endurance issues: Low muscle tone can make even simple activities tiring.

How Hypotonic Cerebral Palsy Affects Daily Life

Children with hypotonic cerebral palsy often require additional support in daily activities. Weak muscle control can make standing, walking, and even holding objects more difficult. Tasks that require sustained effort, like sitting upright for long periods, may be exhausting. Some children may also experience breathing difficulties due to reduced muscle tone in the chest.

Despite these challenges, many children with hypotonic cerebral palsy can make significant progress with the right treatment and support. Early intervention is key to helping them develop strength, coordination, and independence.

Treatment Options for Low Muscle Tone in Children

1. Physical and Occupational Therapy

Therapy plays a crucial role in managing hypotonic cerebral palsy.

• Physical therapy focuses on building strength, balance, and coordination through targeted exercises.
• Occupational therapy helps children develop fine motor skills needed for daily activities like dressing, eating, and writing.

2. Bracing and Orthotic Support

Children with weak muscle tone often benefit from orthotic devices such as ankle-foot orthoses (AFOs) to provide stability and improve posture. These supports help prevent joint misalignment and make walking easier.

3. Speech and Feeding Therapy

If low muscle tone affects the face, mouth, or throat muscles, speech therapy can help improve swallowing, speech clarity, and oral motor function. Specialized exercises and feeding techniques may also be introduced to ensure safe and effective eating.

4. Strengthening Exercises

Engaging in activities that encourage movement, such as swimming or adapted sports, can help build muscle endurance and improve coordination. Therapy programs are often designed to make exercise fun and engaging for children.

5. Surgical Interventions

For children with severe joint instability or posture-related issues, surgical intervention may be necessary. Dr. David Siambanes is a board-certified orthopedic surgeon and fellowship trained in both pediatric orthopedics and spinal deformities. He specializes in procedures that enhance mobility and sitting tolerance, helping children maintain better posture and reduce pain. As the director of the Motion Analysis Center, he uses advanced gait analysis technology to assess movement challenges and determine the best treatment options.

The Importance of Early Intervention

Early diagnosis and treatment of hypotonic cerebral palsy can significantly improve a child’s ability to move, engage in daily activities, and build independence. With the right combination of therapy, bracing, and medical interventions, many children can achieve greater mobility and quality of life.

Dr. Siambanes is dedicated to providing specialized care for children with hypotonic cerebral palsy. Whether through therapy, orthotic support, or surgical solutions, his goal is to help every child reach their full potential.

How Dr. Siambanes Can Help

Hypotonic cerebral palsy presents unique challenges, but with the right support, children can make remarkable progress. Through expert medical care, therapy, and adaptive strategies, families can help their children build strength and confidence in their abilities.

If you have concerns about your child’s muscle tone or mobility, click here to request a consultation with Dr. Siambanes. Together, we can create a personalized plan to support your child’s development and well-being.